Purpose Malignant peritoneal mesothelioma (MPM) is a rare and aggressive tumour involving the peritoneum, typically secondary to asbestos exposure. Left untreated, survival is grim. With CRS & HIPEC (Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy), survival for these patients has improved dramatically. Despite improved survival, less is known about patients’ quality of life (QoL) following this radical procedure. This study reports the QoL outcomes in patients undergoing CRS & HIPEC for MPM at Royal Prince Alfred Hospital. Methodology A prospective cohort study involving consecutive patients undergoing CRS & HIPEC for MPM was undertaken. Demographic, surgical and QoL data was collected prospectively and longitudinally. QoL was assessed using the Short Form-36 (SF-36) health survey at baseline, then quarterly to 12 months after surgery. QoL trajectories for MPM patients are reported and this is also compared to normative data for Australian population. Results There were 12 males (57%) patients with a median age of 63. Median peritoneal carcinomatosis index was 28. Complete cytoreduction was achieved in 12 (57%) patients. Median disease-free survival was 34.6 months and overall survival was 47.7 months (IQR 32.6 – 62.7). At baseline, MPM patients scored lower on each domain of SF-36 compared to general Australian population indicating poorer QoL, persisting after treatment. Both physical and mental component scores decline after surgery but near complete recovery is achieved by 6 months. Conclusion There is insignificant short-term QoL changes in those undergoing CRS & HIPEC for MPM. Understanding factors that drive QoL are important to improve cancer survivorship.